Healthcare Provider Details

I. General information

NPI: 1750020830
Provider Name (Legal Business Name): CREXMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262 E BROADWAY RD STE 106
MESA AZ
85206-6101
US

IV. Provider business mailing address

6262 E BROADWAY RD STE 106
MESA AZ
85206-6101
US

V. Phone/Fax

Practice location:
  • Phone: 602-575-5147
  • Fax: 602-847-2604
Mailing address:
  • Phone: 602-575-5147
  • Fax: 602-847-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: UCHE IKE
Title or Position: OWNER
Credential: DNP, APRN
Phone: 713-397-3324